The current utilization of imaging after primary treatment for prostate cancer - Abstract

March 26, 2015

INTRODUCTION: Data on utilization of imaging after primary treatment for localized prostate cancer are limited.

PATIENTS AND METHODS: We identified 8,435 men newly diagnosed with non-metastatic prostate cancer in 1995-2012 who enrolled in CaPSURE. Patients were followed after primary treatment with radical prostatectomy (RP), cryosurgery (Cryo), brachytherapy (BT), external beam radiation therapy (EBRT), or androgen deprivation therapy (ADT). Use of bone scans (BS), computed tomography (CT) and magnetic resonance imaging (MRI) after primary treatments were assessed. Factors associated with post-treatment outcomes (number of imaging tests, time to first imaging, time to salvage treatment) were evaluated with multivariate Poisson regression and Cox proportional hazards regression.

RESULTS: Utilization of post-treatment BS, CT, and MRI was ≤ 20%. Last post-treatment log(PSA) was associated with having multiple post-treatment imaging tests. Management with RP, Cryo, EBRT, or BT versus ADT was associated with lower likelihood of receiving post-treatment-imaging. Of those imaged post-treatment, 25% of RP patients and 9% of radiation patients underwent imaging prior to PSA failure. Salvage treatment-free survival was 81% at 5 years. Positive findings on post-treatment imaging were associated with higher risk of salvage treatment.

CONCLUSION: Patients managed with ADT for localized disease were most likely to be imaged, primarily with BS. Men treated with other therapies were less likely to be imaged and tended to have CTs. Imaging may add value to post-treatment PSA monitoring to identify disease recurrence and progression. Further studies are needed to establish guidelines for optimal frequency and type of imaging to monitor the treatment response.

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